Cardiology 01
Independent cardiology practice cuts denial rate from 18% to 6%
A growing single-location cardiology group needed clearer oversight of high-value claims, payer follow-up, and recurring denials.
- Practice type
- Independent cardiology, single location
- Location
- Southeast US
- Provider count
- 3 physicians
- Engagement length
- 90-day implementation
| Period | Value | Phase |
|---|---|---|
| Month 1 | 18% | Before engagement |
| Month 2 | 15% | Before engagement |
| Month 3 | 11% | After engagement |
| Month 4 | 9% | After engagement |
| Month 5 | 6% | After engagement |
The challenge
High-value diagnostic and interventional claims — echo, ECG, PET, chronic care management — were denying at nearly one in five, mostly from bundling errors and inconsistent documentation. Nobody owned follow-up on aged claims, so denials sat until they aged out of the appeal window.
Our approach
We introduced specialty-aware claim review against cardiology bundling rules, built a recurring denial-review rhythm the practice could actually sit in, and assigned named ownership for every aged claim over 30 days.
How the engagement unfolded
- Week 1–2 Workflow mapping Reviewed 90 days of claims history to find where bundling and documentation gaps were costing the most.
- Week 3–6 Front-end and coding fixes Corrected recurring bundling errors and tightened documentation review before submission.
- Week 7–10 Denial cleanup Worked the existing backlog of aged claims while new claims began going out clean.
- Week 11–13 Stabilize and report Denial rate held under 8%; monthly reporting handed to the practice for ongoing visibility.
We were losing revenue fast until we fixed our coding and documentation process. Last month alone, dozens of previously denied claims got paid.
Figures on this page are an illustrative example of a typical engagement, not measured results from a named client. Your own outcome depends on your payer mix, specialty and current workflow.
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